CASES; Back to Work and Life, With a Fresh Perspective

By PETER B. BACH, M.D.

Published: April 5, 2011

I was in the car with Ruth, headed home from one of her last radiation treatments at Memorial Sloan-Kettering Cancer Center.

Traffic was maddening. It was dusk. It was cold and lightly raining. It had been eight months since Dr. Hiram Cody felt the lump in her breast. Surgery had gone smoothly enough. Chemotherapy had carried side effects, but we had gotten through. Now there were just a few more days of radiation to go.

Sloan-Kettering, as it happens, is where I work. Only a few days earlier I had completed a two-week rotation on the clinical service there, helping train residents and medical students to evaluate people with lung problems.

It was my first time seeing patients since my wife's diagnosis. I had developed a deep anxiety about getting back out there, about putting on my white coat and gliding through the corridors. Could I do my job? Would I collapse in ruins the moment I met a patient who reminded me of Ruth? Could I see a fellow husband of a breast cancer patient and just soldier on?

But in the first few moments back on the clinical ward, everything felt pretty normal. The young doctors would tell me about the next patient, we'd review some lab results and X-rays, and then we'd walk into the patient's room.

Mostly I stuck to my routine. I had decided I would ask our patients more questions about their lives before cancer, about the initial treatment and the expectations that came with it.

I'd like to say that through this questioning I acquired a deeper empathy for their experience, and that through these stories I was led to make better-informed clinical decisions on my patient's behalf.

Perhaps. That would be the dogma, and a tidy consequence of Ruth's and my experience. Then I would be living proof of Sir William Osler's insight that ''he who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.''

But my motives were simpler. I wanted to make sure that the doctors in training, and the medical students who followed us, saw a person as well as a patient. I wanted them to see that the patient - along with the spouse holding that patient's hand, and the family members gathered around - had only just crossed the line from the land of the healthy to the land of the sick.

I was not imparting a profound insight or seeking to do something novel or unusual. I was just following through on the most basic elements of being a doctor.

But I did change one small part of my routine, so small I doubt my trainees even noticed. Sometimes going into a patient's room, I would position myself to face the other doctors. I'd ask to sit on the bed beside the patient, or walk around it to the other side.

Until now I had always stood with my fellow physicians, just far enough into the room that we would all fit. We'd form a kind of cabaret line, minus the high kicks. Stoop-shouldered, all in our white coats, stethoscopes variously hanging around necks or out of lab coat pockets. All in a line.

Sometimes, I'd even cross my arms. Ruth calls it my doctor pose.

In that pose, I saw myself as a consultant, an expert coming in to scope out the problem and make decisions. But by positioning myself so I can see both the patient and the other doctors, I can focus not only on my own concerns but theirs - on what they are hearing and seeing and feeling.

The shift in perspective matters. I'd always viewed patients as visitors in our hospital. But after a year of being on the other side of the desk, I've realized that we are the ones who are visitors in their lives.

Now, driving home in the thick traffic a few weeks later, I peered out the front window as Ruth sat next to me, having removed the uncomfortable wig after we left her radiation treatment. She felt her hair was still too short to go out in public without it.

We came to a stoplight. A tall blond guy about our age crossed in front of us, talking on his cellphone. Despite the overcoat and umbrella, Ruth recognized him immediately.

''That's Kent,'' she said, then fell silent.

I hadn't met Kent, but I knew who he was - her college boyfriend, with whom she had stayed in touch even after their relationship faded and he moved overseas.

Maybe on another day, before the cancer, Ruth would have leapt from the car to say ''Hi,'' or told me to honk to get his attention. But the light changed, and he was gone around the corner.

There I sat, the doctor next to his cancer-patient wife. We were already looking forward to reclaiming our life from the illness. But through her I felt the diminishment it had caused and knew how unfair it would always feel.

A few months passed, and we were sitting on the beach, as I had promised her right at the beginning of her treatment. Ruth's hair was fully back.

It was a perfect late summer day. Carolina blue sky, a few crisp white clouds, crashing surf with a rich sheen, wind rustling through kites, occasional laughter around us. Our little family and many others.

''I'm so glad we're not missing this,'' Ruth said.

Yet there was nothing exactly to miss. Just the weather to smell, the cold sand to feel, and the slow rhythm of the waves and faster beat of the wind to hear.

Sometimes a day comes along that unpredictably ends up punctuating the story of your life. It was that kind of day.

This is the last in a series of articles. This article appeared in print on Tuesday, April 5, 2011 on page D5.

This is a more complete version of the story than the one that appeared in print.